Services provided through the first-ever PPP in the Kyrgyz Republic make better care available to most of the country’s kidney disease patients. © Fresenius
Bektur Abdiev has worked for nearly three decades in a dialysis unit at the National Center of Cardiology and Therapy in Bishkek, the capital of the Kyrgyz Republic. The doctor oversees every dialysis session in the busy unit—a “lifeline,” as he calls it, for patients suffering from kidney failure.
But in the Kyrgyz Republic, not all patients are as lucky as those Abdiev watches over. A nationwide shortage of equipment and expertise means that only 20 percent of people who need dialysis have access to it through the country’s public health centers. The tragic result is that nearly 1,000 Kyrgyz citizens die every year from kidney failure.
Although many of those deaths could have been prevented, “Our medical system has struggled to provide quality dialysis treatment,” says Abdiev. Dialysis clients “face problems like outdated facility and equipment, difficulty controlling infections among patients, and poor water quality.”
Abdiev and many of his colleagues believe that a new public-private partnership (PPP) expected to dramatically improve dialysis services across the country will better serve patients and their families. With support from Austria's Federal Ministry of Finance, the Swiss State Secretariat for Economic Affairs (SECO), and the Hungarian Export-Import Bank, IFC helped deliver the country’s first-ever PPP—making it possible for Fresenius Medical Care to provide cutting-edge dialysis services to patients across four major cities of the Kyrgyz Republic, including the capital. About 75 percent of the country’s total population will be covered by the centers. The private investment in the country’s health-care system demonstrates that investors have confidence in the nation and facilitates future investments.
Fresenius Medical Care is expected to set up four advanced dialysis centers and start providing the services to patients in mid-2018. A dialysis session will include coverage of all necessary drugs; prior to this transaction, public dialysis patients had to purchase these expensive medicines themselves. In another leap forward for patients, the company will introduce peritoneal dialysis, a procedure that allows individuals to perform dialysis at home. Because dialysis treatment requires three sessions per week, each lasting at least four hours, the new offering is among the most sought-after solutions on the market. It can dramatically improve patients’ quality of life—especially for those who live in rural areas, far from hospitals, and for children with chronic kidney disease. This is the first time it will be available in the Kyrgyz Republic.
To raise the level of medical expertise among health-care professionals, the company will also provide intensive training and ongoing educational opportunities for doctors and nurses. The project preparation was initiated and financed by Germany’s Ministry of Economic Cooperation and Development, through KfW development bank, and supported by the governments of Austria, Hungary, and Switzerland.
Kyrgyz government officials view this PPP as an important step forward for the country’s public health services. The transaction is "market-changing,” according to Talantbek Batyraliev, the Kyrgyz Republic's Minister of Health. He believes that “High-quality kidney care services, and more accessible, affordable dialysis” will ensure that citizens will receive care that patients in other parts of the world regard as routine.
IFC has helped other countries secure better dialysis care for their citizens. In Romania, for example, the introduction of a fixed fee for treatment has resulted in a more transparent pricing system for dialysis services. The government has adopted strict national quality standards and applied them to both privately- and publicly-managed clinics.
In Bangladesh, where less than 10 percent of the 1.6 million people with end-stage renal disease were receiving dialysis treatment, IFC helped design a PPP that increased the country’s capacity to provide dialysis services by eight-fold and ensured it was affordable for poor patients. This PPP was just given a special award at the Asia Pacific PPP Awards for its “exceptional outcome and for very innovative and unique use of a PPP to help address a significant social need.”
In these countries, and in the Kyrgyz Republic, improving dialysis services will help ease the load for overstretched local hospitals, boost the efficiency of medical centers that provide routine and specialized care to patients, and reduce patients’ time, travel, and expense.
IFC’s support does not end when the new medical centers open their doors to Kyrgyz kidney disease patients. Alongside KfW, IFC will provide post-transaction advisory help to the Ministry of Health to monitor the PPP agreement and build its capacity to manage technical and operational issues.
Demand for health care is growing rapidly in developing countries. IFC’s roles include direct and indirect investment in health-care and life-sciences companies, sharing industry knowledge, raising management and clinical standards, and supporting public-private collaboration in health.
This PPP is a good example of how IFC meets those goals. As the Kyrgyz Republic transforms its health-care system, IFC is also ensuring equitable access to high-quality services to those most in need, as well as training for medical providers.
“We can now look ahead with much more confidence,” said Abdiev, the doctor. “Thanks to innovative technology and treatment practices, we could save thousands of lives.”
To learn more about IFC’s work in public-private partnerships, visit www.ifc.org/ppp.
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Published in December 2017.